If you’re a human being—and if you’re not and you’re reading this blog, please let us know immediately—you may not be eating or absorbing enough in Vitamin B12 particularly if you are older, pregnant, vegetarian (especially vegan), or have trouble absorbing food. But those are not the only populations that might not be getting enough of this important vitamin.
For example, did you know that the likelihood of Vitamin B12 deficiency increases if you have diseases like Crohn’s or celiac that impact your digestive system or conditions such as lupus or Graves’ disease that weaken your immune system? And if you’re taking certain medications that can interfere with absorption of B12—including some commonly prescribed oral drugs for diabetes (e.g., metformin) and popular medications for acid reflux or heartburn (e.g., Nexium, Tagamet)—you may also be at greater risk for Vitamin B12 deficiency.
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Although some experts say that most people in the U.S. consume adequate amounts of Vitamin B12, others advise that the most recent National Health and Nutrition Examination Survey in the U.S. found that Vitamin B12 deficiency in the general adult population ranges from 3%-26%, depending on the cut-off used.
What most everyone seems to agree upon is that a Vitamin B12 deficiency can be serious.
Why is Vitamin B12 Important?
Vitamin B12 (cobalamin) is one of the 13 essential vitamins and one of eight essential B vitamins. It’s one of the better known “Bs” although others in the family, like B9 (folate/folic acid) and B6 (pyridoxine) also carry some buzz.
When talking about vitamins, the term “essential” technically refers to the fact that the vitamins must be obtained from your diet (which could include supplements) because your body cannot make enough vitamins to meet its needs for growth, function and healthy maintenance.
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Like all of its sister Bs, Vitamin B12 is a water-soluble vitamin—versus one that is fat soluble like Vitamin D—which simply means it dissolves in water. And from a practical standpoint, you can take B12 supplements with or without food, whereas fat-soluble vitamins usually need to be taken with food.
One more thing to know about water-soluble vitamins: your body doesn’t store them, so in order to maintain healthy levels, be sure that you are regularly getting B12 from the foods you eat and if you are supplementing, be consistent with your daily usage.
What Does Vitamin B12 Do Exactly?
First and foremost, Vitamin B12 plays a part in producing red blood cells, which carry oxygen through your body. It also helps keep your nerve cells working properly and produces DNA, the genetic material that lives in most of your body’s 30 trillion cells. But wait, there’s more.
Vitamin B12 is not known as the energy vitamin for nothing. It supports your metabolism as it assists in synthesizing fatty acids and energy production. And another benefit is its ability to help prevent anemia, a blood condition related to dysfunctional red blood cells that results in making people tired and weak.
It could also impact some depressions and mood disorders—high levels of Vitamin B12 have been associated with improved odds of healing from major depressive disorder—and could play a role (more research is needed!) in memory loss and possibly even dementia.
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What is just as important as what B12 does is what happens if you don’t get enough. Deficiencies of this nutrient can cause fatigue and low energy, as well as nerve, brain and spinal cord problems. This can lead to difficulty with balance and walking and can be irreversible if not recognized early and corrected.
And that same article from WebMD that talked about the benefits of B12, noted that in one study of disabled older women, those with a B12 deficiency had double the risk for severe depression as those in the study population who were not B12 deficient.
Pregnant women with low levels of B12 are more likely to miscarry or give birth prematurely and their babies-to-be are three times more likely to be born with birth defects.
Poor cognitive function and developing dementia are also strongly associated with B12 deficiencies.
Where Does B12 Come From?
You’re not going to find Vitamin B12 in plants, you can’t get it from the sun, and your own body does not produce it on its own. Fortunately, there are other ways that you can ingest it or inject it in order to reap the benefits.
Start with food. Here are 10 popular choices.
- Fish—we always start with salmon, because of the multiple benefits from this healthy fish, including all the juicy omega-3 EPA and DHA it confers.
- More fish—sardines, tuna, trout, herring
- Beef—beef is a great way to get your Vitamin B12.
- Beef liver—before you turn up your nose— (did you grow up with the smell of liver and onions in a frying pan?)—just know that beef liver (3 ounces gets you 2,450% of the daily value (DV).
- Clams—like their fishy cousins, clams are rich in Vitamin B12. Their seafood sisters, oysters, mussels and scallops are other fine options.
- King crab legs—enough said!
- Cheese—Swiss cheese, please, tops the list here. Other cheesy treats with B12 include mozzarella, feta and brie.
- Eggs—yum! Do keep in mind it’s the yellow yolk that packs the B12 punch.
- Chicken—a 3 oz. breast provides just 12% of the DV.
- Fortified breakfast cereals—there’s no shame in getting your daily Vitamin B12 fix from this option. (There may be a little shame involved if it’s happening at dinner.) Be sure to check the label on the box to ensure it’s fortified with Vitamin B12 and to understand what else, if anything, it’s fortified with.
Check out this article, for more Vitamin B12-rich foods and their comparative daily value for that vitamin, and even some recipes.
Supplement with dietary supplements. If you’re not getting enough B12 from food alone, you can up your B12 intake through supplements. That’s a good way to fill the gap between what you need and what you’re already getting.
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Although it is fairly easy to quickly reach the recommended dietary allowance (RDA)—it’s 2.4 mcg for adults 19 and over (and higher for pregnant and breastfeeding women)—especially if you are adding supplements to your diet. However, you don’t need to worry if you surpass the RDA in this case. That’s because with a water-soluble vitamin such as B12, your body uses what it needs, and the rest is flushed out through your urine.
In addition, there is a safe harbor between the RDA and what is known as the upper limit (or Tolerable Upper Intake Level), defined simply as the level at which there is no known toxicity.
But don’t use those facts as excuses to take extremely high doses, which may have side effects. The NIH Office of Dietary Supplements advises supplements with 1,000 mcg are safe. Check the Supplement Facts on your supplement product label to see how much vitamin B12 your supplement contains and don’t exceed the serving recommendations unless directed by a healthcare practitioner.
You will find B12 in multivitamins, single letter B12 vitamins, B-complex vitamins and sometimes in other supplements. A wide variety of companies sell B12 vitamin supplements and you won’t necessarily get the same % of DV in each product, so be sure to compare and contrast by carefully looking at the Supplement Facts label.
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There are many companies selling dietary supplements, some more trustworthy than others, so choose your brand carefully as you would with any product for your health.
Consider other options. Getting your dose of Vitamin B12 is most commonly achieved through food and/or dietary supplements; however, vitamin B12 is also available as sublingual tablets or lozenges that dissolve by placing them under your tongue as well as nasal sprays/gels. Or, if needed, your doctor can prescribe a stronger dose of oral Vitamin B12.
Some people may need to raise their intake through Vitamin B12 drips or injections, which may be medically warranted. Check with your doctor or other healthcare practitioner as these forms are usually recommended to treat a Vitamin B12 deficiency, although some celebrities are trying to trend-up drips and injections of B12 for the energy buzz and so-called skin glow.
What Are the Symptoms of B12 Deficiency?
Like so many other serious health conditions, many of the symptoms associated with Vitamin B12 deficiency aren’t unique to that specific problem. Here are just some of the symptoms which might mean you suffer from a Vitamin B12 deficiency:
- extreme fatigue
- joint pain
- deep depression
- memory loss
- changes in behavior
- shortness of breath
- heart palpitations
- trouble walking
- decreased appetite
- and more
It’s no wonder that the Harvard Health Blog says a Vitamin B12 deficiency can be sneaky and harmful, advising that people are often unaware they are critically low until they experience very serious consequences.
A Vitamin B12 deficiency requires a medical diagnosis. Your doctor will take a health history, conduct a physical exam and may order tests to determine your B12 levels to start. But B12 status is not routinely included in the bloodwork panel that doctors generally order. So, you may have to ask.
But blood tests from your doctor are no longer the only game in town. There are also tests available for in-home use—and they can, in fact, be quite useful.
How Do You Know if Your B12 is Low and What do You do to Correct It?
Rather than reach the point where you are experiencing serious symptoms that could point toward a Vitamin B12 deficiency, doesn’t it make sense to regularly test your Vitamin B12 levels to determine if they are low, before getting to the point of deficiency? After all, you can’t correct a problem until you know it exists.
You can request that your doctor test your Vitamin B12 levels, which are easily tested through a blood test that then determines your B12 status. Another simple option is an at-home urine test from OmegaQuant, which can be ordered online, and may actually provide a more accurate reading. More on that in future blogs.
TEST: The Methylmalonic Acid Test (A B12 Status Marker)
For most people, low Vitamin B12 levels (and even a deficiency) can usually be reversed by adding B12 to your diet and/or through supplements. But for some deficiencies, the treatment can take as long as 12 months, and in some cases, nerve damage may be permanent.
Be active about your B12 levels. That’s our first piece of advice, but not our last, on this topic.